Methods and systems for lowering blood pressure through reduction of ventricle filling
View Patent ↗Methods and devices for reducing ventricle filling volume are disclosed. In some embodiments, an electrical stimulator may be used to stimulate a patient's heart to reduce ventricle filling volume or even blood pressure. When the heart is stimulated in a consistent way to reduce blood pressure, the cardiovascular system may over time adapt to the stimulation and revert back to the higher blood pressure. In some embodiments, the stimulation pattern may be configured to be inconsistent such that the adaptation response of the heart is reduced or even prevented. In some embodiments, an electrical stimulator may be used to stimulate a patient's heart to cause at least a portion of an atrial contraction to occur while the atrioventricular valve is closed. Such an atrial contraction may deposit less blood into the corresponding ventricle than when the atrioventricular valve is opened throughout an atrial contraction.
1. A system for reducing ventricular filling volume in a patient having a pretreatment ventricular filling volume, comprising:
a stimulation circuit configured to deliver a stimulation pulse to at least one cardiac chamber; and
at least one controller configured to execute the delivery of one or more stimulation patterns of stimulation pulses to at least one cardiac chamber, wherein at least one of the stimulation pulses has a first stimulation setting and at least one of the stimulation pulses has a second stimulation setting different from the first stimulation setting, at least one of the first stimulation setting and the second stimulation setting being configured to reduce or prevent atrial kick, thereby reducing the ventricular filling volume from the pretreatment ventricular filling volume.
2. The system of claim 1 , wherein the first stimulation setting and the second stimulation setting are configured to reduce or prevent atrial kick.
3. The system of claim 1 , wherein the first stimulation setting has a different AV delay than the AV delay of the second stimulation setting.
4. The system of claim 1 , wherein at least one of the one or more stimulation patterns is repeated at least twice in a period of one hour.
5. The system of claim 1 , wherein the at least one controller is configured to execute the one or more stimulation patterns consecutively for a time interval lasting 10 minutes or longer; and
wherein the first stimulation setting is configured to reduce or prevent atrial kick in at least one ventricle for at least 50% of the time interval.
6. The system of claim 5 , wherein the second stimulation setting has a longer AV delay than the first stimulation setting.
7. The system of claim 5 , wherein the one or more consecutive stimulation patterns comprise at least one stimulation pulse having the first stimulation setting for at least about 75% of the time interval.
8. The system of claim 5 , wherein the time interval is at least 30 minutes long.
9. The system of claim 5 , wherein the time interval is at least one hour long.
10. The system of claim 5 , wherein the time interval is at least 24 hours long.
11. The system of claim 1 , wherein the one or more consecutive stimulation patterns comprise at least one stimulation pulse having a third stimulation setting different from the first stimulation setting and the second stimulation setting configured to reduce or prevent atrial kick in at least one ventricle.
12. The system of claim 1 , wherein the one or more consecutive stimulation patterns comprise at least one stimulation pulse having a third stimulation setting different from the first stimulation setting and the second stimulation setting and configured not to reduce or prevent atrial kick in at least one ventricle for less than about 50% of the time interval.
13. The system of claim 12 , wherein the third stimulation setting is configured not to reduce or prevent atrial kick in at least one ventricle for about 20% or less of the time interval.
14. The system of claim 1 , wherein the one or more stimulation patterns comprise a sequence of 10-60 stimulation pulses having the first stimulation setting, the first stimulation setting being configured to reduce or prevent atrial kick in at least one ventricle, and a sequence of 1-10 heartbeats embedded within the 10-60 stimulation pulses, the sequence of 1-10 heartbeats having a longer AV delay than the first stimulation setting.
15. The system of claim 14 , wherein the sequence of 1-10 heartbeats includes at least one stimulation pulse having a first stimulation setting configured to reduce or prevent atrial kick in at least one ventricle.
16. The system of claim 14 , wherein the sequence of 1-10 heartbeats includes a natural AV delay.
17. The system of claim 14 , wherein at least one heartbeat of the sequence of 1-10 heartbeats occurs without stimulation.
18. The system of claim 1 , wherein the first stimulation setting is configured to reduce atrial kick in at least one ventricle and the second stimulation setting is configured to reduce the baroreflex response to the reduction in atrial kick such that the increase in blood pressure values occurring between stimulation pulses is limited to a predetermined value.
19. The system of claim 18 , wherein the second stimulation setting is configured to allow an increase in blood pressure from about 1 heartbeat to about 5 heartbeats.
20. The system of claim 18 , wherein the stimulation pattern includes multiple stimulation pulses having the first stimulation setting.
21. The system of claim 20 , wherein the stimulation pattern includes multiple stimulation pulses having the second stimulation setting.
22. The system of claim 21 , wherein between about 1% of the multiple stimulation pulses and 40% of the multiple stimulation pulses of the stimulation pattern have the second stimulation setting.
23. The system of claim 21 , wherein the stimulation pattern includes a ratio of stimulation pulses having the first stimulation setting to the stimulation pulses having the second stimulation setting that corresponds to a ratio of time constants of the response to increase and decrease in blood pressure.
24. The system of claim 19 , wherein the first stimulation setting includes a first AV delay and the second stimulation setting includes a second AV delay, the first AV delay being shorter than the second AV delay.
25. The system of claim 24 , wherein the stimulation pattern includes multiple stimulation pulses having the first stimulation setting.
26. The system of claim 25 , wherein the stimulation pattern includes multiple stimulation pulses having the second stimulation setting.
27. The system of claim 26 , wherein between about 1% of the multiple stimulation pulses and 40% of the multiple stimulation pulses of the stimulation pattern have the second stimulation setting.
28. The system of claim 26 , wherein the stimulation pattern includes a ratio of stimulation pulses having the first stimulation setting to the stimulation pulses having the second stimulation setting that corresponds to a ratio of time constants of the response to an increase and decrease in blood pressure.
29. The system of claim 26 , wherein the at least one stimulation pattern includes a ratio of about 8 to about 13 stimulation pulses having the first stimulation setting to about 2 to about 5 the stimulation pulses having the second stimulation setting.
30. The system of claim 1 , wherein one of the first stimulation setting and the second stimulation setting is configured to invoke a hormonal response from the patient's body.
31. A system for reducing ventricular filling volume of a patient having a pretreatment ventricular filling volume, comprising: a stimulation circuit configured to deliver a stimulation pulse to at least one cardiac chamber; and at least one controller configured to execute the delivery of one or more stimulation patterns of stimulation pulses to at least one cardiac chamber, wherein at least one of the stimulation pulses includes a setting configured to cause a ventricular excitation to commence between about 0 ms and about 70 ms after the onset of atrial excitation, configured to reduce or prevent atrial kick in at least one ventricle, thereby reducing the ventricular filling volume from the pretreatment ventricular filling volume.
32. A system for reducing ventricular filling volume in a patient having a pretreatment ventricular filling volume, comprising:
a stimulation circuit configured to deliver a stimulation pulse to at least one cardiac chamber;
at least one controller configured to execute the delivery of one or more stimulation patterns of stimulation pulses to at least one cardiac chamber for a time interval lasting 10 minutes or longer, wherein at least one of the stimulation pulses has a first stimulation setting configured to reduce or prevent atrial kick in at least one ventricle for at least 5 minutes of the time interval and at least one of the stimulation pulses has a second stimulation setting different from the first stimulation setting, thereby reducing the ventricular filling volume from the pretreatment ventricular filling volume.
33. A method of reducing ventricular filling in a patient having a pretreatment ventricular filling volume, comprising:
delivering one or more stimulation patterns of stimulation pulses to at least one cardiac chamber for a time interval lasting 10 minutes or longer, wherein at least one of the stimulation pulses has a first stimulation setting configured to reduce or prevent atrial kick in at least one ventricle for at least 5 minutes of the time interval and at least one of the stimulation pulses has a second stimulation setting different from the first stimulation setting, thereby reducing the ventricular filling volume from the pretreatment ventricular filling volume.